New Jersey Judiciary
Superior Court - Family Division
County of
Review Date
Board #
Voluntary Placement
Review Board Recommendation to the Judge
Review Type:
Status
Child
Special
Date of Birth
Age
Permanency
Division Case Manager / Supervisor
NJSpirit Participant #:
Docket #
FC-
FN-
FG-
Next FN court date
Next FG court date
Date of Current Placement
FJFFNext FJ-FF court date
Yes
No
Repeated Placement
If yes, Date of original placement
Date of Family Summary / Case Plan /
Court Report -- Out-of-Home
(DCF Form 26-81a)
Authority for Placement
Residential
Independent Living
Division Placement Type (Short Term Plan)
Resource Home – Relative
Resource Home – Foster Care
Resource Home – Family Friend
Group Care Home
Institution (Med / Rehab / Psych)
Residential Facility (Educ / Treatment)
Other (explain)
Division Long Term Goal
Reunification w/ Parent / Guardian
Permanency w/ Relative / Family Friend
Other alternate permanent living arrangement (explain / attach documentation)
If the Long Term Goal is Adoption:
Relative
Foster Parent(s)
Selected Home
1. Agency placement plan for this child satisfies legal criteria (N.J.S.A. 30:4C-55, -58, and -60)?
2. Current goal is
Current plan is
Acceptable
Acceptable
Yes
Undetermined
No
Not Acceptable
Not Acceptable
3. Date the Division proposed goal / plan is to be achieved:
Yes
No -- If No, Review Board goal date:
Date satisfies Review Board?
4. Is there a current
health form?
Yes
No
5. Is there a current
education form?
Yes
No
6a. Is there an independent living assessment?
Yes
No
(if child is over 14 yrs., attach documentation)
6b. Is there a current independent living plan?
Yes
No
(if child is over 16 yrs., attach documentation)
After Reviewing All Information Presented, the CPR Review Board Recommends the Following:
Choose Only One:
A. Continued placement of the child outside of the home is not in the child’s best interest and the child should be returned
home within two (2) weeks and the Division or designated agency, as appropriate, shall provide reasonable and available
services which are necessary to implement the return home.
B. Continued temporary placement outside of the home is in the child’s best interest until the long-term goal is achieved.
C. Continued temporary placement outside of the home is in the child’s best interest, but there is not sufficient information
for the board to make a recommendation, therefore, the board requests the court to order the Division or designated
agency, as appropriate, to provide the needed information within two (2) weeks of the Court Order.
In addition, we further request: (Choose One or More)
1. Sufficient information to be provided within two (2) weeks
(Date)
2. Case plan to be modified within thirty (30) days
(Date)
3. New plan and goal to be reviewed within thirty (30) days
Appearances:
Mother
Father
Resource Family(s)
Division Supervisor
Revised Form Promulgated by Directive #04-13 (06/24/2013), CN: 11354
4.
5.
6.
7.
Summary Hearing
CASA assigned
Red Flag - special conditions exist
Other
Division Caseworker
Other
page 1 of 2
Voluntary Placement – CPR Board Recommendation
Child’s Name:
Docket #: FC-
Board members attending review (initials only)
Chairperson
Board Member
Board Member
Review Date:
Board Member
Board Member
Original reason(s) for placement / Case Summary
Reunification / Risk to child
The conditions / circumstances leading to the removal of the child have been corrected and it is safe to return the child
home at this time or in the near future for the reasons set forth here:
It is NOT and will NOT be safe to return the child home in the foreseeable future because:
Reasonable Efforts
Has the Division provided reasonable efforts to finalize the permanent plan including reunification where appropriate?
Yes
No
Explain:
Compliance
One or more parties are complying with the Division’s plan (explanation)
One or more parties are not complying with the Division’s plan (explanation)
Board Recommends:
Additional Comments / Questions:
Barriers to permanency at the time of this review:
Housing
Parent training
Please Mark U= Unavailable or I= Inadequate
Substance abuse services
Physical handicap services
Emergency Shelter
Homemaker services
Low cost medical services
Pregnant teen services
Emergency funds
Educational / School services
Mental Health services
Bilingual client services
Day Care
Employment / Vocational services
Mental handicap services
Other
Termination of Parental Rights: (Permanency Reviews Only)
Termination of Parental Rights was granted on the date listed below:
Mother
Father
on
, 20
on
, 20
Termination of Parental Rights to be followed by Adoption is an appropriate plan because:
This case is an exception to the requirement to file Termination of Parental Rights because:
The child is living with a relative
The Division has not provided necessary services to effect family reunification
The following compelling reasons exist in this case:
Permanent reason OR
until this date
Revised Form Promulgated by Directive #04-13 (06/24/2013), CN: 11354
page 2 of 2